49-02-236 p 54-55new19_J_Eng.

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7/19/06

11:29:57 PM

Patients Suing
Doctors:
Jeopardizing the
Doctor-Patient
Relationship

Complaints to the Medical

Council of Thailand
According to a Medical Council
of Thailand report on January 2006,
258 cases of possible medical
malpractice were submitted to the
Medical Council from 1993 to 2005.
This is 8 cases per 1,000 doctors or
4.1 per 100,000 members of the
general public. The issues most
frequently raised were professional
standards and advertising (see
chart).

P 54_J

The number of patients suing their doctors

has been increasing in Thailand. Some
cases have been brought to court, others
have been brought to the Medical Council
of Thailand, and others have been pursued
in the media. Accusations of medical
malpractice inevitably jeopardize the
relationship between health workers and
patients. It is currently unclear how the
rise in malpractice suits will affect Thailand.

49-07-075_54-55new21_J_Eng.ai

7/21/06

4:53:45 PM

Medical Malpractice Cases Brought

to the Medical Council of Thailand
1993 to start of 2005
Issues

Number Pecentage

Medical Profession Standard

Medical Profession Advertisement
Professional Dishonor
Negligence of Patients Safety and
Unnecessary Loss
Infraction of Laws
Issue of false certification and comments
in bad faith
Support of illegal profession
Lack of respect toward professional colleague

Since the establishment of the Medical Council

of Thailand in 1968, only 2 doctors have had their
licenses revoked. It is easy to understand why people
choose instead to pursue their cases through the
media.

Discourtesy to patient
Refusal to provide patient with assistance
Experiment on humans without consent
Total
Source: Medical Council of Thailand.,2006. Issues brought to
sub-committee of the Medical Council of Thailand from 1993 to
present. Photocopy.
C

CM

MY

CY

CMY

According to Dr. Somsak Lolekha, President of

the Medical Council of Thailand, malpractice suits
have a number of causes: a decline in professional
standards; a deterioration of the relationship between
doctors and patients, which results in poor communication; inappropriate promises to patients; unrealistic
expectations among patients; treatment costs that
are too high for patients to pay; and doctors failure
to seek patients views. In some cases, doctors
intentionally mislead patients, which leads the patient
to mistrust the doctor once the truth is known.
In January, 2005 there were 353 complaints
pending before the Medical Council 218 from the
period before 2005, and 135 from the year 2005. Of
the 218 complains from the period before 2005, the
Medical Council upheld 76 (36%) and rejected 138
(65%).

From the Case of Dolaporn to the

Case of Dokrak
Medical malpractice had a high profile during
the year 2005. The Nonthaburi Provincial Court
ordered the Office of the Permanent Secretary to pay
Mrs. Dokrak Phetprasert 800,000 baht damages
plus interest at the rate of 7.5% per year for a 6-year
period (2,000,000 baht in total). Mrs. Phetprasert
became completely blind after taking drugs prescribed
to her by a doctor at Nakhon Sawan Pracharak
Hospital.
Even though it was not the first time a patient
had been to court to defend his or her rights, the
Dokrak case received a great deal of attention
from medical personnel in Thailand.
Ten years ago, Mrs. Dollaporn Lorsermwattana,
President of the Medical Victims Network, filed a
lawsuit against Phya Thai 1 Hospital, over a incident
during childbirth that caused her son to be disabled.
She pursued the case for 13 years, but it was eventually
dismissed by the court because too long had elapsed
since the time of the incident.
Many victims of medical malpractice are not
able to seek justice because of a lack of medical
and legal knowledge. Sometimes the legal procedure
can add to the suffering of the victim, who therefore
chooses to withdraw charges or seek a compromise,
rather than reaching the same outcome as the
Dollaporn case.

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47-07-075_56-57new_J_Eng.ai

7/20/06

1:44:32 AM

Examples of Malpractice Suits Reported the Minister of Public Health, stated that the death
was due to the medical malpractice. The Medical
in the Media during 2005
Pyelic CalculusMrs. Sumali Nikornsaen filed
a lawsuit against doctors of Ramathibodi Hospital
following the death of Mrs. Rabiab Chuihiran, who
had been treated for pyelic calculus. The doctors
claimed that the death was caused by excessive
blood loss, while Dr. Winit Puapradit, Director of
Ramathibodi Hospital, said that there was a
misunderstanding between the doctors and the
patients relatives.
Nong DreamMr. Poolsawat Pitoontham, a
garage owner in Lat Phrao, filed a lawsuit against
doctors of Ramkhamhaeng Hospital following the
death of his 4-month-old daughter, Pannita Pitoontham,
or Nong Dream. The girl had been showing symptoms
of listlessness and a lack of appetite. The doctors
claimed that the death was due to blood infection.
Death after DeliveryMr. Akanit Tempiroj
asked the police to bring charges against Lt. Col. Dr.
Yanyong Imsuwan, an obstetrician at Ekpathum
Hospital, after the death of Mrs. Paijit Mueangtum
from intrapartum haemorrhage. The doctor argued
that the death was due to placenta praevia.
Vegetative state due to dental treatment
Mrs.Tiwakarn Onyai sought compensation for
malpractice against her son Chanayuth Patangthane,
who suffered brain injuries during dental treatment
in 2003, causing him to enter a vegetative state. In
January 2006, the Nonthaburi Provincial Civil Court
ordered the Ministry of Public Health to pay
2,400,000 baht compensation to the son and to pay
1,070,000 baht compensation to the mother, plus
7.5% annual interest and 20,000 baht in lawyer
fees.

The Nong Sen Case: Conflict between

the Minister of Public Health and the Medical
Council of Thailand
A recent case clearly showed the doctors
professional organization to be protecting its members
rather than patients. In 2005, doctors at Samut
Prakan hospital twice refused to admit a patient
named Pirachat Chanarawee, or Nong Sen, who
was suffering from a 41C fever. Nong Sen
subsequently died. Mr. Phinij Charusombat,

P 56_J

Council of Thailand asked for a meeting with the

minister to clarify the issue. The meeting was followed
by a seminar on The Crisis in the Relationship
between Doctors and Patients on January 13,
2006.
Dr. Cherdchoo Ariyasriwattana, secretary of
the Medical Councils administrative subcommittee,
stated that the Medical Council did not necessarily
disagree with the substance of the ministers
comment. Rather, the Medical Council was worried
that the comment might threaten morale among
doctors, who had to work under conditions of shortage
and limited budgets. Moreover, all medical care
carries some risks, no matter how careful the
doctor.
Dr. Ariyasriwattana stated that civil and criminal
lawsuits against doctors had already caused some
district hospitals to suspend operations or deliveries,
especially in complex cases. Instead, patients are
sent to provincial or regional hospitals, which are
better equipped. She suggested that the government
set up a compensation fund to assist patients
suffering from complications from treatment.
Compensation need not depend on whether the
doctor was responsible, especially when the doctor
had complied with professional standards.

The Medical Councils Proposal

The Medical Council of Thailand has released
a Draft Statement announcing that its members
(which means all doctors in Thailand) have the right
to choose whether to perform examinations and
treatments in non-urgent cases, for the patients
benefit. This statement can be interpreted as
protecting doctors from being sued for negligence.
The Medical Council has stated that it will
release a revised statement in 2006. The revised
statement may clarify patients rights, to improve
the relationship between doctors and patients.

A Compensation SystemThe Solution?

Medicine and public health undeniably have a
commercial dimension. In many cases, the doctor

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7/19/06

11:31:31 PM

is service provider and the patient is a customer,

and there is more to the relationship than curing
people or saving lives. If there is no effective damage
management system for the medical service, then
lawsuits against the doctor will increase enormously.
This will inevitably hurt the general public.
In the United States, there is a compensation
system called Financial Medicine, whereby doctors
buy indemnity insurance with high premiums and
carry out excessive examinations and treatment,
which is known as defensive medicine. Dr. Sanguan
Nittayarampong, Secretary-General of National
Health Security Office, states that in the USA, 25%
of all public health costs, or 4% of GDP, are used for
legal procedures or insurance instead of treatment.
In the United Kingdom, New Zealand, Canada,
Finland, and France, there is compensation system
that does not try to establish guilt, but instead to
establish whether the illness or injury really was
caused by medical intervention. Compensation
funds provide assistance to victims, and central
committees investigate problems in the health
system. The advantages of this approach is rapid
compensation of victims and a dramatic reduction in
lawsuits, which are generally 3-4 times less common
than in the United States.
In these countries, it was doctors who campaigned
for compensation systems, to protect themselves
from being sued. In contrast, in Thailand, it has
been the victims rather than the doctors who want a
compensation system. Doctors are preoccupied
with protecting themselves in court.
In Thailand, under Article 41 of the National
Health Security Act 2002, compensation is provided
only to families covered by the government health
insurance system. This is nevertheless a first step
towards reducing health system inefficiencies and
avoiding conflict between doctors and patients. If
legal measures are used for prosecuting physicians
for malpractice, conflicts between doctors and
patients will be worsened. Even more importantly,
legal measures may harm the health system, since
people will have to pay more, and doctors may
refuse to carry out treatments.
In 2004-2005, the National Health Security
Office paid compensation amounting to 17 million

baht under Article 41 of the National Health Security

Act 2002. Of this amount 4.5 million baht was paid
in 2004, and 12.7 million baht in 2005.
In 2004, there were 85 requests for compensation,
of which 62 were successful. In 2005, there were
218 requests, of which 179 were successful. The
majority of cases (66%) were related to death,
disability, and loss of organ. (See chart).
The number of those suffering from medical treatment
and receiving primary grants in the fiscal year of
2004-2005

62 Cases
179 Cases

Death/Permanent
Disability

Loss of organ

2547 paid compensation

amount 4,525,000 baht
2548 paid compensation
amount 412,765,000 baht

Injury/Chronic
IIIness

Source : National Health Security Office, 2005

Thailand appears to be following the American

model. Insurance companies have begun offering
malpractice insurance to medical professionals.
Lawsuits against doctors have become a new
source of business for some law firms. If these
trends continue, then ordinary people will be the
ones to suffer because:
(1) People will have to pay the costs of doctors
malpractice insurance and excessive treatment
due to defensive medicine, including over-use of
medical technology.
(2) Unnecessary treatment not only wastes resources,
but can also cause harm. According to a US Institute
of Medicine report, medical mistakes cause 50,000
100,000 deaths yearly in the US, which is more
than the numbers of deaths from accidents.
(3) The relationship between doctors and patients
deteriorates. Doctors and patients trust medical
treatments, but patients and their families loose
faith in the medical system.

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47-07-075_70-71new_J_Eng.ai

7/20/06

12:23:33 AM

Pregnancy,
Abortion,
and Child
Abandonment:
Neglected
Problems

Premature
pregnancy,
abortion and child abandonment
According to data from the
Child Watch Project, Bangkok is
the province with the highest rate
of child abandonment, with 7.43
children abandoned per 100,000
population. The average for the
whole country is 2.61 per 100,000.
There are 700-800 babies and
children abandoned per year, or
about two per day. This number
excludes aborted fetuses found in
public places. There are reports
of women suffering post-partum
haemorrhages in public toilets
after committing abortions by
themselves. The Ministry of Social
Development and Human Security
estimates that in 2003-2004,
1,975 babies were abandoned at
hospital, with baby sitters, or at
public places.

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In 2005 the newspapers carried stories

about child abandonment, discovery of
discarded aborted fetuses, and raids on
abortion clinics. There is little sign, however, that Thais are willing to take a comprehensive view of these problems and or to
adopt systematic measures to address
them.

47-07-075_70-71new_J_Eng.ai

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12:11:25 AM

Source: Child Watch Project in each province,

Ramjitti Institute
[http://www.childwatchthai.com].

Number of Abandoned Children per 100,000

Population, 2005, by Region
Regions

Ratio

Bangkok
Center
East

as were cases of HIV/AIDS. Cases of postpartum bleeding and abortion-related infection

have been increasing among teenagers.

Upper North
Lower North
Northeast
South
Whole country

Child abandonment is closely linked to

unintended pregnancy. Statistics collected in
2001 by the Reproductive Health Rights
Campaign Project suggest that Thai society has
a major problem with unintended pregnancies.
The researchers collected data on pregnancies
from 925 women aged 15-59 in two communities
in North and Northeast Thailand. Of the 2,496
pregnancies, 45% were unplanned, and 16%
were aborted. The most commonly cited
reason for aborting, given by over half the women
who had abortions, was economic difficulties.
The group with the most abortions was 20-29year-old women.
The Age of Women having Abortions is
Falling
Dr.Suriyadev Tripati, head of the of Teenage
Clinic at the Queens National Childrens
Health Institute, states that around 20% of
females who give birth at the hospital are less
than 20 years old. There have been cases of
13-year-old girls having their second pregnancies.
Thai children do not receive formal sex education
until they over 13 years old, even though
increasing numbers of 13-year-olds are having
unprotected sex.
These ideas have been verified by new
research conducted in 2005. A national study
of sex and violence conducted among 200,000
13-18 years old, mainly in grades 7 to 12,
found that the age of first sexual intercourse
was falling over time. Some students aged 13
were having sex. The pregnancy-abortionabandonment phenomenon was found,

New Abortion Methods

If they become pregnant, teenagers try to deal
with the situation using their limited personal experience
and knowledge. Many traditional abortion methods
are based on the traditional medical concept of
hot substances. Many women can acquire and
use traditional abortion medicines themselves. At
present the most popular modern medicine is
Cytotec, a drug used for treatment of gastric disorders,
but which can cause abortions. It appears that
women learned about this drug when it was used in
hospitals to treat incomplete abortions, and that
information about the drug has spread informally.
Dr. Wichai Thienthaworn, Permanent Secretary
in the Ministry of Public Health has described other
popular abortion methods. One is the use of weightreduction medicines. Another is acne medications.
These are inexpensive and widely available, but
can easily lead to haemorrhaging, physical malformities in the baby, and incomplete abortions.
Incomplete abortions can have a long - term impact
on womens health. Use of the drug is particularly
dangerous for 4-5 months pregnancies.

Government Efforts to Address the

Problems are Poorly Coordinated
Though the issues of unintended pregnancy
and abortion are becoming more serious, some
people try to add to the difficulties of girls who have
become pregnant. Major government figures argue
that, if teenage girls do not respect the traditional
value placed on virginity, the problem will be
insoluble. Measures to suppress abortion clinics
are unlikely to decrease the abortion rate, but will
instead push the problem underground, making it
impossible to provide safe, high-quality services.

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47-07-075_72-73new_J_Eng.ai

7/20/06

12:18:24 AM

Looking for Light at the End of the

Tunnel

Dr. Tares Krassanairawiwong, Director of the

Medical Licenses Division, Ministry of Public Health,
has stated that the Ministry can determine whether
an abortion service is legal, and whether the doctor
has a license, but cannot punish offenders.
To offer an alternative to abortion, the Office of
Child Protection and Welfare Promotion, Ministry of
Social Development and Human Security, attempts
to make agreements with pregnant women are
do not wish to bring up their children. It offers two
possible solutions. The first is for the state to care
for the child until the mother is ready for instance,
once she has graduated or found a job The mother
will then be provided with information about the
childs location. The other solution is for the state to
care for the child permanently.
The Department of Health, Ministry of Public
Health, has launched a program on Thai teenagers
reproductive health, in cooperation with tertiary
education institutions. A course about sex education
is added to the undergraduate curriculum to provide
teenagers with access to accurate health information
about sex and reproductive health. Special health
services are established, tailored to teenagers
needs. The program also aims to set up places in
every secondary school where teenagers will have
access to information and advice about sex and
reproductive health.
There are, however, continuing controversies
over providing information and birth control services
to teenagers. Many Thais argue that teenage sex is
not acceptable, and that services should not be
provided. Such views are common among teenagers
themselves. According to a 2005 survey, only 41%
of teenagers agree with the installation of condom
vending machines in tertiary educational institutions.
Almost as many37%disagree with the idea, and
23% neither agree nor disagree.

Concerned at the scale of the problem of teenage

pregnancy, the Ministry of Education has supported
some pilot projects by nongovernmental organizations
(NGOs). Teachers from across the country have
been provided with sex education materials designed
for all age groups, aiming to improve students
coping skills. The materials aim not to control
childrens thoughts and values, but rather to provide
them with a beneficial learning process.
Effective sex education programs may be able
to reduce the risk of early childbearing. However,
many other measures will be needed. Pregnancy,
abortion, and child abandonment are all complex
issues. An integrated solution is essential.

Success Through Coordinated Efforts

Thai society needs to take immediate measures
to address the problem of unintended pregnancies,
abortions, and abandonment. Such measures
should lead to a long-term, sustainable solution.
There must be cooperation between the government
and society.
(1) Measures to reduce the number of infants
abandoned and the number of abortions
- Provide comprehensive advice and information
to women with unintended pregnancies, respecting
the rights and needs of the women.
- Provide accommodation to women about to
deliver in every province, together with standard
maternity services.
- Organize adoption services and temporary
childcare services.
- Establish clear procedures to assist women
who have become pregnant as a result of rape.

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12:18:50 AM

More Teenagers Need

Taught about Birth Control

(2) Measures to reduce social pressure on

women with unintended pregnancies
- Education institutions under the Ministry of
Education must revise their procedures for dealing
with pregnant students. They should place greater
emphasis on the care of the students and less on
the reputation of the school, and they should help
these students to achieve good academic results.
- All governmental and non-governmental
organizations should ensure that access to services
for children is not affected by the marital status of
the parents.
(3) Measures to reduce unintended pregnancy
- Information and birth control services must
be provided to all young people, but particularly
unmarried females, including junior high school
students and girls not attending school. Birth control
centers should be established in communities.
- Educational materials should identify
gender inequities in traditional views on sex, and
should attempt to promote equality between women
and men. These materials should be provided to all
people, including people not in school.

to

be

Many girls first experience of sex is probably

similar to that of Kaew. She was in a long-term
relationship built on love, trust, and sharing. Then
one day, her boyfriend told her that a relationship
without sex was not love.
Before then, I didnt let him touch my hands or
body. When he talked about it, I refused, completely
refused. I had never thought about sex before. I
thought it should be after marriage. I never thought
that he would force me.
Not only had she not thought about sex she
had also not thought about protecting herself from
pregnancy.
I did not dare. It was very embarrassing. I
never talked about it. I knew nothing about birth
control. I dont know where to begin and how to
take the medicines.
When her boyfriend raised the issue of sex,
she was a 17 year old student in her final year at
high school. She had one older brother and one
younger brother. Everyone regarded her as a
respectable girl, which made her proud. She had
been going out with her boyfriend, a senior student
from the same school, for 5 years. Both families
knew and had no objection to their relationship. The
boyfriends parents were waiting for him to spend
time as monk, and for Kaew to graduate from
university, before they held a wedding ceremony.
A few months after their first night together,
Kaew found that she was pregnant. She asked her
family for advice. They sympathized with her
situation, and let her make her own decision. She
decided to keep the baby, with assistance from her
family. However, her boyfriend was worried about
his parents reaction.
Kaew was concerned about her boyfriend, and
had an abortion, costing 5,000 baht. Her life and
that of her boyfriend returned to normal.
Birth control should be taught more widely. I only
learnt about AIDS. If you go anywhere in Thailand,
you can see lots of children born before their
parents were ready. These children may become
beggars or thieves. Their future is hopeless. We
can avoid this, if we make birth control more widely
known.
Source:Would like you know : The diary of the experience of the unwanted
pregnant woman. Campaign project to reproductive rights., Meeting document
The Alternative of the unwanted pregnancy. Organizing by the Population Council.
(6 July 2000).

47-07-075_74-75new_J_Eng.ai

7/20/06

12:24:59 AM

The Continuing
Struggle Against
Alcohol and
Tobacco

Campaigns and legislative measures

to reduce consumption of alcohol
and tobacco remain important.
Their success depends on the
determination of civil society and
the sincerity of the government.
The aim is to reduce the economic
and social costs of alcohol and
tobacco and to improve social and
individual health.
Thailand is a world leader in
the control of alcohol and tobacco.
In the last five years, the combined
efforts of civil society and the
Thai Health Promotion Foundation
(ThaiHealth) have led to many
new measures to restrict alcohol
and tobacco use. For instance,
retailers may now only sell alcohol
between 11:00 AM and 2:00 PM
and between 5:00 PM and midnight,
children under 18 are prohibited
from buying alcohol and tobacco,
and cigarette packets must now
carry vivid pictorial warnings. The
public has become particularly
concerned about alcohol and
tobacco use among the young,
so youth have been a major
target of new policies.

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47-07-075_74-75new_J_Eng.ai

7/20/06

12:25:26 AM

Campaigns to Reduce Smoking, 20052006

A 2004 Statistical Office survey on smoking
habits found that 11.3 million Thais aged 15 and
older smoke. Of these, 9.6 million smoke every
day. Over 90% of smokers started smoking when
they were young. Tobacco companies therefore
focus their advertising campaigns on young people.
In 2005, the government, together with civil
society, attempted to strengthen measures to prevent
smoking among youth. Sale of alcohol and tobacco
to children aged less than 18 was prohibited, and
Thailand became one of the first countries in the
world to use pictorial warnings on cigarette packets.
After the Ministry of Public Health mandated the
display of pictorial warnings, 21% of smokers who
saw the warnings quit smoking, 57% percent
reduced their consumption, and 22% continued as
before.
However, the number of smokers still needs to
be reduced further. Many young people are still
able to buy tobacco because the regulations against
sales to minors are not rigorously enforced.
Advertisements at point of sale and in the media
are still effective in persuading young people to
smoke. Accordingly, in 2005 and 2006, a number of
new, proactive measures were introduced:
1. Prohibiting shop displays. Tobacco
companies put a great deal of emphasis on the
display of cigarettes at the point of sale because it
is the best opportunity to persuade customers to
buy their product. Displaying cigarettes alongside
sweets, snacks, and chewing gum increases their
appeal to young people. Across the world, tobacco
companies spend 100 billion dollars, or 4 trillion
baht, per year on advertisements, giveaways, and
promotions at point of sale, out of a total advertising
budget of 4.56 trillion baht.
To help control advertisements at point of
scale, the government has been using Article 8 of
the 1993 Tobacco Control Act, which prohibits the
advertising of tobacco products, including the
inclusion of symbols or brand names in print, radio,
or television. The Ministry of Public Health announced
that by February 24, 2005, all retailers had to
remove tobacco products from displays and

counters. Shops that advertised products in violation

of the ruling would receive fines up to 200,000
baht.
Faced with dramatic losses of sales, the
company Seven-Eleven, together with international
and domestic tobacco producers, exploited loopholes
in the legislation. Eventually, the case went to the
Supreme Court. Meanwhile the companies came
under heavy pressure from the public, forcing
Seven-Eleven to back down and give up its fight in
the courts.
2. Increasing cigarette taxes. As of 2005,
Thailand had not increased cigarette taxes for four
years, despite that fact that economic growth had
improved and incomes had increased by 10%.
Sales of cigarettes increased from 1,727 million
packets in 2001 to 2,110 packets in 2004.
Accordingly, in September 2005, the government
increased the stamp duty on cigarette packets from
75% to 79%. This was just under the maximum
level of 80% defined by the Tobacco Act of 1966.
The tax rise was expected to reduce consumption
by about 10%.
In addition, the government intends to amend
legislation in order to raise the ceiling for tobacco
taxes above 80%. If the ceiling is raised to 200% or
300%, the government will be able increase
tobacco taxes immediately, without having to issue
new legislation. Tobacco producers predict that
consumption will fall by 7% in 2006. The Customs
Department predicts that it will fall by 10-12%.
Meanwhile, the increased taxes are expected to
raise an extra 3 billion baht in tax revenues.
3. Increasing smoke-free zones. Thailand
has two kinds of smoke-free zone. In the first,
smoking bans are rigorously enforced, to protect
the health of non-smokers. In the second, there are
exceptions to protect the health of smokers. On
December 30, 2005, the Ministry of Public Health
made two announcements. It displayed a new
smoke-free zone symbol, and it announced three
new types of smoke-free zone, increasing the total
from 31 to 34. The new zones include lobbies of
air-conditioned hotels, clinics for traditional Thai
medicine, and all healthcare businesses.

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12:26:42 AM

Healthcare businesses are defined to include

health spas, massage parlors, and beauty and
health clinics. The original legislation referred to
train carriages, but only ones with air-conditioning.
This was amended to cover all train carriages. The
new rules came into force in January 2006. The
reduction in exposure to second-hand smoke should
help reduce cancer rates among nonsmokers.

In 2005, Alcohol Continued to Ensnare

Increasing Numbers of Young People

Measures Implemented in 2005-2006 to

Combat Abuse of Alcohol

Alcohol consumption has clear effects on the

economy. Costs include productivity losses, health
care expenditures, and crime and violence. Alcohol
is the third biggest disease risk factor in Thailand,
behind unsafe sex and tobacco. The cost of
alcohol-related traffic accidents alone is around
2-3% of national income, or about 100 billion baht
per year. If all the costs of alcohol were included,
the total losses from alcohol would likely be more
than 500 billion baht per year.
In 2005, ABAC Poll, Assumption University,
surveyed Thais about their alcohol use and their
attitudes to alcohol. The survey was conducted in
Bangkok and surrounding provinces and covered
1,672 people. Of those aged 15 and older, 55%
said that they consumed beer. Average consumption
was 3.8 glasses per day. Forty-five percent drink
occasionally and 10% drink every day.Thai beer
was the most popular alcoholic drink,followed by
Thai spirits and imported spirits. Average income
was 8,825 baht per month, and average expenditure
on alcohol was 3,588 baht per month. Most drinkers
had received one or more injuries while drunk.
Fifteen percent of drinkers said that it affected their
mood, 14% said it caused them to loose employment,
and 13% said it reduced their productivity. Fifty-two
percent had no plans to give up drinking, and of
those who planned to give up, 78% had not yet
succeeded.
In addition to its economic effects, alcohol also
imposes social costs. Alcohol contributes to violence
within the family and in the larger society. A survey
of newspapers and websites between January
2002 and June 2005 identified 3,427 court cases
involving alcohol-related violence. There were 1,198
such cases in 2003, 944 cases in 2004, and 422
cases in the first six months of 2005. Altogether, there
were 1,146 cases of assault, 963 murders, 440
rapes, 321 accidents, and 229 suicides.

1. Increases in Alcohol Tax. At present, the

Excise Department has two rules for setting the tax
on alcohol. Alcoholic beverages can be taxed
according to their price or according to the amount
of alcohol they contain. Whichever rule yields the
higher tax is the one that is used. For spirits the
maximum possible rates are 50% of the price or
400 baht per liter. However, until recently the actual
rate used was 240 baht per liter. On September 6,
2005, the same day that it raised tobacco taxes, the
cabinet announced that the tax on spirits would be
increased to maximum levels. Mixed spirits such as
Mekong Whisky and brandy would be taxed at a
rate of 400 baht per liter. Brandy, which had been
taxed at a rate of 35% of its selling price, would be
taxed at 40%.
The new measures did not include rice whisky
or medicinal spirits, which are defined as traditional
beverages. The reason for excluding traditional
beverages was to assist community industries.The
National Institute of Health has recommended that
the same tax rate be applied to all types of alcohol,
and that the tax be increased slowly, so as to avoid
encouraging black market production. Similarly, the
Center for Research on Alcohol argued that the
government should not grant an exemption for rice
whisky because rice whisky is the cheapest and
most popular form of alcohol. It is also the form of
alcohol most preferred by people with low incomes,
particularly youth.
In Chiang Mai Province, for example, the number
of shops selling the cheap types of whisky preferred
by young people increased from 389 in 2003 to 482
in 2005, a rise of 21%. These shops are most
common where there are concentrations of people,
such as in crowded communities, or near student
accommodation and massage parlors.

47-07-075_76-77new_J_Eng.ai

7/20/06

12:27:06 AM

2. Restricting times and places where alcohol is

sold and restricting advertising. From January 1,
2006, the Ministry of Finance issued new rules on
the registration of shops selling alcohol. Gas
stations and shops at schools and religious instittions
were no longer permitted to sell any sort of alcoholic
beverage, including beer. The Excise Department
would not extend the alcohol licenses of around
10,000 gas stations. Altogether, 580,000 shops
throughout the country are licensed to sell alcohol.
Licenses are normally renewed in December.
New rules have also been introduced limiting
the times during which alcohol can be sold. The two
legal periods are 11:00 AM - 2:00 PM and 5:00 PM
to midnight. The government also has plans to ban
the sale of alcohol on Sundays, which is supposed
to be the day for families. A ban on alcohol sale on
Sundays would help bring families closer together
and reduce social problems.
Most importantly, in 2006 the Ministry of Health
announced a ban on all forms of alcohol advertising,
in all media.
3. Increased penalties for drunk drivers. In
2005, the government amended the 1979 Transport
Act, to increase penalties for the use of motor
vehicles while under the influence of alcohol or
drugs. In cases where the driver caused an accident,
the penalties vary according to the severity of the
physical and mental injuries caused. Maximum
prison terms range from 3 to 10 years, and maximum
fines range from 60,000 to 200,000 baht. The court
can revoke a drivers license without having to wait
for the final verdict.

The Most Important Step: Changing

Behavior
The aim of the all these policies is to reduce
consumption of alcohol and tobacco. If this aim is
achieved, then the damage that tobacco and alcohol
do to the economy, society, and peoples health will
be reduced. Effective implementation of the policies
will require cooperation from all concerned and
determination from the government.

The efforts of people campaigning against alcohol and tobacco over the last 10 years bore fruit in
2005-2006. Thailand now has a set of proactive
policies deterring people from consuming tobacco
and alcohol. It is now necessary to change public
perceptions, so that people become less tolerant of
tobacco and alcohol use. New attitudes would
make it easy for users of tobacco and alcohol to
give up.
Success in changing attitudes depends on
networks formed by groups involved in the struggle
against tobacco and alcohol. Governmental and
non-governmental organizations can together educate
the public to change smoking and drinking habits.
This is not just a task for health workers. Effective
measures will require knowledge from many fields
and systematic implementation. It will require
sufficient budget, and support from all levels of the
government.
Special attention needs to be paid to young
people, to prevent them from taking up smoking
and drinking in the first place. To deal with people
who already abuse tobacco and alcohol, effective
measures will be needed to help them quit. There
must be policies to protect non-smokers from
second-hand smoke and to protect non-drinkers
from injuries and property damage caused by drinkers.
Changing behavior and attitudes requires
participation from trendsetters in the media and
entertainment sectors. It requires participation from
all parts of society, and social marketing. It requires
the use of government policies and the legal system.
Schools will need to teach children not to smoke
and drink, and anti-smoking and anti-drinking
messages will need to be broadcast in the popular
media.

47-07-075_78-79new_J_Eng.ai

7/20/06

12:28:42 AM

The Consumers
Association:
Another Step
Forward for Thai
Consumer Power

Most Thai consumers have

poor access to information,
and are regularly cheated
by government and private
producers. However, there
is little cooperation among
consumers to oppose unfair
practices. It is time for
Thais to establish an independent organization to
protect consumers rights.
In the present consumerist
era, it seems that every person
in the country has been cheated
when purchasing goods or services.
People are sold genetically modified
food, or fruit and vegetables
grown with unsafe chemicals.
They buy cheap electrical goods
that do not work. They buy major
items such as cars or houses
that do not live up to the claims
in the advertisements. They are
misled by advertising campaigns
about SMS services.

P 78_J

47-07-075_78-79new_J_Eng.ai

7/20/06

12:28:03 AM

In 2005, the mass media

devoted substantial attention to
problems faced by consumers.
Incidents reported in the media
raised public consciousness about
consumer issues, and led to calls
for an independent organization
to defend consumer rights. Article
57 of the 1998 Constitution states
that the rights of consumers must
be protected. The law provides
for an independent organization
consisting of consumers representatives that provides input into
legislation, regulations, and standards.

The Car Demolition that

Drew the Attention of the
World.
In early 2005, a shopkeeper
named Duenpen Silaket drew the
attention of the world when she
demolished a car in front of the
media to protest against unfair
treatment by the cars manufacturer.
Her brand new four-wheel drive,
costing 1.3 million baht, would
not start and its steering veered
to the left, despite numerous
repairs. The manufacturer refused
to provide her with a replacement
vehicle, claiming that none of the
other 100 vehicles had had any
faults. Eventually Duenpen Silaket
took a great deal of satisfaction in
smashing the vehicle for the benefit
of reporters. Thai consumers all
over the country followed the
story with interest.
Eventually, to save face, the
manufacturer bought the vehicle
back at the original sale price.
Within days, owners of virtually
every other make of car flooded
the media with stories

about problems with their cars and about the manufacturers lack of
concern. People invented many new forms of protest.One person set
a car on fire. One put a car in a coffin and laid a wreath on it. In March
2005, a group of people smashed cars in front of a large crowd at a
car show.
When, in March 2005, the complaints began to affect car sales,
the Office for Industrial Standards and the Motor Vehicle Institute
quickly set up the Center for Quality Assurance. Within a month, the
Center had received 190 complaints. Car companies also began to
pay more attention to manufacturing quality and service. The number
of complaints to the Center gradually decreased.

Painting a House Black to Protest Eleven Years of Problems

In 2005, Rattana Satjathep painted her house black to protest
against the builders of the house. In doing so, she ignited a national
campaign among dissatisfied house owners. The house owners were
assisted by the Consumers Foundation. Their aim was to put pressure
on the government agency responsible for regulating construction
businesses.
Ms. Satjatheps problems began more than 10 years ago. The
house began to develop numerous cracks, after her neighbors all
began extending their houses. Ms. Satjathep asked the local authorities
to prevent the neighbors from doing further building. However the
authorities told her that if they were going to take a case against the
neighbors, they would also take a case against her. They claimed that
she had encroached onto public land by building a house in a place
where people reversed their vehicles. However, the local authorities
had themselves issued Ms. Satjathep with a building permit many
years before.
Over the following years, Ms. Satjathep appealed to many
different government organizations, but was always disappointed. All
she hoped for was to find an official who would enforce the law, for
her own sake and for the many other house owners whose rights had
been violated by government officials or construction companies. At
the time of writing (February, 2006), the government inspectors have
still not responded to Ms Satjatheps requests. This sort of
inefficiency is typical for official building inspectors.
After 11 years of problems, the governor of Bangkok Province
and the Human Rights Commission addressed Ms. Satjatheps
concerns by arranging for her to receive 12.5 million baht compensation,
so that she could buy a house elsewhere in Bangkok.
Ms. Satjathep and Ms. Duenpen are both ordinary, powerless
people, but the determination they showed has had a major impact
on the automobile manufacturers and construction companies and on
the rights of Thai consumers. They serve as an example for other
consumers.

P 79_J

49-07-075_80-81new21_J.ai

CM

MY

CY

CMY

7/21/06

5:33:30 PM

Making Money from Text Messages (SMS).

Many television programs invite people to cast
votes on the program using text messages on their
mobile phones. A big scandal occurred in 2005
when the programs Big Brother and Fantasy Academy told people to vote participants off the show,
and then allowed people to vote the rejected participants back on. The producers boosted their
profits at the expense of the viewers who voted.
Downloading on to Mobile Phones. Some
companies discovered a new way to make money,
particularly from children: charging people to download music and pictures. The conditions of sale
were ambiguous. Some customers used the
service only once, but received further downloads,
and were charged for these too. Some customers
had to pay for calls that were supposed to be free.
Download services were advertised in magazines
and websites, and reached all the target groups.
Advertisements for Products to Become
Slimmer, Younger, and Whiter. These products
were aimed mainly at women. They promised to
improve their appearance, by, for instance, making
them paler or slimmer.
Dangerous Bus Services in Bangkok. Many
people were killed or injured while using bus
services in Bangkok. Some cases were featured in
the news while others were not. Most deaths and
injuries occurred on privately-run buses. These
buses charge more than publicly run buses, but
their service is no better.
Substandard Electrical Goods. Cheap imported
electrical products that do not conform to Thai industrial specifications last a short time before they
have to be replaced. They add to the electronic
waste threatening the countrys environment.

The Roots of the Problems Facing Consumers in Thailand

One of the most important reasons that consumers rights are weak is the Thai legal system.
The country has in fact had a government agency
responsible for consumers rights since 1979. It is
called the Office of the Committee for the Protection of Consumers, and belongs to the Office of the
Prime Minister. An Act to protect the rights of
consumers was also passed in 1979 and amended
in 1998. The Act sets out five rights:
1. Consumers must be provided with accurate
information about products 2. Consumers can
freely choose products or services 3. Goods should
be safe to use 4. Contracts must be fair 5. The right
to an investigation and compensation if the previous four rights are violated

P 80_J

In addition to this Act, there are many other

rules and regulations designed to protect the
rights of consumers. There are 38 further Acts
dealing with consumer issues, including one
passed in 2004, regulating direct sales. There
are two Royal Decrees, a 1988 Royal Ordinance
about misleading lending, and 11 Ministerial
Orders.
However, this body of legislation is rarely used,
because of gaps in the legislation and because the
government agencies responsible for enforcing the
rules do not take their jobs seriously. The case of
Rattana Satjathaep is a clear example. Even
though she collected together all the necessary
documentation on infractions by the construction
companies and the local administrators, no one
was ever punished, and she had to wait 11 years
for her concerns to be addressed.
Another important reason for the weakness
concerning enforcement of consumers rights is
that there is no forum for consumers to voice their
concerns, and no one provides consumers with the
information and skills necessary to deal with
advertising. Many people, particularly rural people,
the poor, and the less-educated, lack information
and options when choosing products, and must
rely entirely on advertising.
Moreover, there has never been any opportunity for representatives from civil society, such as
leaders of independent organizations or students
organizations, to provide input into laws and regulations. Consumers are scattered and unorganised.
Groups trying to protect consumers interests lack
the money and/or ability to bring consumers together to oppose powerful business interests. Similarly, the Office of the Committee for the Protection
of Consumers is unable to act quickly, because of
bureaucratic red tape. It is therefore unable to
control the thousands of retailers and producers
who cheat consumers.
The government has done little to force
producers to disclose information about products,
including information about the safety of food,
medicine, cosmetics, surgery, and agricultural
chemicals. Consumers therefore only learn about
the positive aspects of the products, and never the
negative aspects. When something goes wrong,
consumers lack the information necessary to complain to the retailers or producers. There is no
organization responsible for approving advertisements or checking that claims made about a product are correct.
The most important problem is the feeling of
powerlessness among consumers. Consumers
who experience problems look to the example of
other people who have taken cases to the courts or
the authorities.

49-07-075_80-81new21_J.ai

7/22/06

9:38:03 AM

Many such people have been accused of infractions themselves, or have wasted large amounts of
time and money. The legal process is very complex
and expensive and takes many years. There are
therefore many silent victims who, despite having
been cheated themselves, have not joined the
struggle to assert the rights of consumers.

Decrease of Cases Reported to Government Organizations; Increase of Cases

Reported to Non-Governmental Organizations

CM

MY

CY

CMY

It is worth noting that in 2005, even though

stories about consumer protests were printed on
the front pages of the newspapers and were pursued in depth by the popular media, the number of
complaints registered at the Office of the Committee for the Protection of Consumers fell. There were
almost 1000 fewer complaints in 2005 than there
were in 2004 (see Table). The peak number of complaints occurred in 1999, when there were about
8000, presumably because retailers increased
unfair practices during the economic crisis.
In contrast, the number of cases reported to the
Foundation for Consumers, a non-government
organization that campaigns for consumers rights,
increased three times between 2004 and 2005 (see
Table). This demonstrates that the public is coming
to trust non-governmental organizations more than
they used to. It also raises questions about the
effectiveness of their governmental counterparts.

Cases reported to the Office of the

Committee for the Protection of Consumers
Type of complaint

1999

2000 2001

2002 2003 2004

2005

House, building, land

Goods and services
Advertisements
Direct sale
Total
Source: Office of the Committee for the Protection of Consumers

Cases reported to the Foundation

for Consumers
Type of complaint

1999

2000 2001 2002

2003 2004 2005

Quality of service
Immovable property

The Consumers Association and Prospects for an Independent Consumers Organization

The numbers of complaints and the stories
reported in the media show that Thai consumers
are facing many problems and need assistance. If
there is no one that consumers can trust to protect
them, then the problems will only grow worse.Tensions will grow between consumers and producers,
eventually damaging the economy. Even though
there are about 100 laws and regulations protecting
the rights of consumers, implementation is
seriously deficient.
There were many infractions of consumers
rights in 2005, and consumers became increasingly
conscious of their rights. This induced con- sumers
groups to increase their effectiveness and improve
cooperation. A network of consumers groups, led
by the Foundation for Consumers Rights and the
Department of Community Pharmacy, Chulalongkorn University, established the Consumers Association. Other participants included groups
concerned with substandard housing, unfair practices, medical malpractice, and debts.
A ceremony to launch the Consumers Association was held on April 24, 2005, at Thammasat
University. The association will receive complaints
from consumers, and will assist consumers who
have received unfair treatment in matters such as
houses, cars, health care services, and debts.
Around 1000 people attended the opening ceremony. The Association Chair, Bangkok Senator
Mr.Dumrong Puttan, noted in a speech that the new
constitution had been in force for eight years, but
Article 57 calling on the government to establish an
independent organization to defend consumers
rights had not yet been implemented. All other
articles in the constitution calling for independent
organizations had been implemented. Under the
Constitution, the Senate cannot establish the organization itself but can only put pressure on the legislature. Politicians in the legislature have, how- ever,
shown little interest.
The founding of the Consumers Association
will help put pressure on the government to quickly
introduce legislation to set up an independent consumer organization and a consumer court. These
institutions would help raise the quality of goods
and services, which would benefit both consumers
and producers.

Health care products and

services
Manufacturing standards
Public utilities
Other (Debts)
Other
Total
Source: Foundation for Consumers

P 81 J

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Department of Livestock Development Ministry of Agriculture and cooperatives Bangkok, Thailand. HPAI in Thailand Available from.
http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/cd/documents/Xraysurvey%20Thailand.pdf.
Emergency Centre for Transboundary Animal Diseases Operations (ECTAD), FAO. Economic and Social Impacts of Avian Influenza.
Available from.[www.fao.org/.../health/diseases-cards/cd/documents/ Economic-and-social-impacts-of-avian-influenza-Geneva.pd].
Ferguson NM, et al. Strategies for containing an emerging influenza pandemic in Southeast Asia.
Nature. 2005, August 5.
Mclood, A., Morgan, N., Prakash, A. and Hinrichs, J. 2005 A Global Strategy for the Progressive Control of Highly Pathogenic Avian influenza(HPAI)
Published in May 2005 by the Food and Agriculture Organization (FAO, Rome) and the World Organization for Animal Health (Office International des
Epizooties - OIE, Paris) in collaboration with the World Health Organization (WHO, Geneva).
T.M. Ellis, et al..Vaccination of chickens against H5N1 avian influenza in the face of an outbreak interrupts virus transmission Avian Pathology
(August 2004) 33 (4), : p. 405-412.
WHO Global Influenza Programme; World Health Organization. Dept. of Communicable Disease Surveillance and Response. Responding to the
avian influenza pandemic threat. Geneva : World Health Organization, 2005.

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